Section 418.101007. Reimbursement for anesthesia services.

Rule 1007. (1) The carrier shall determine the maximum allowable payment for anesthesia services by adding the base units to the time units. The carrier shall reimburse anesthesia services at either the maximum allowable payment, or the practitioner's usual and customary charge, whichever is less. Each anesthesia base unit shall be multiplied by $42.00 to determine payment for the base procedure.

(2)   Anesthesia base units shall only be paid to an anesthesiologist, a surgeon who provides the anesthesia and performs the surgery, or a certified registered nurse anesthetist providing anesthesia without medical direction of the anesthesiologist. Only 1 practitioner shall be reimbursed for base units, documented by the anesthesia record.

(3)   The carrier shall reimburse the time units by the total minutes listed in the "days" or "units" column and the alpha modifier added to the procedure code. Time units are reimbursed in the following manner:

(a)  Increments of 15 minutes or portions thereof, for administration of the anesthesia.

(b)   Increments of 30 minutes or portions thereof, for supervision of a CRNA or certified anesthesiologist assistant.

(c)   In no instance shall less than 1 time unit be reimbursed.

(4)     The maximum allowable payment for anesthesia time shall be calculated in the following manner:

(a)   If the anesthesiologist administers the anesthesia, then the modifier shall be -AA and the maximum payment shall be $2.80 per minute.

(b)   If the anesthesiologist supervises a CRNA or certified anesthesiologist assistant, then the modifier shall be QK and the maximum payment shall be $1.40 per minute.

(c)    If a CRNA or a certified anesthesiologist assistant supervised by an anesthesiologist administers the anesthesia, then the modifier shall be -QX and the maximum payment shall be

$2.80 per minute.

(d)   If a CRNA administers without supervision of the anesthesiologist, then the modifier shall be -QZ and the maximum payment shall be $2.80 per minute.

History: 1998-2000 AACS; 2014 AACS; 2015 MR 17, Eff. Sept. 15, 2015.